The rise of a European healthcare union

Abstract:

Healthcare has only slowly appeared on the European Union’s (EU) policy agenda. EU involvement in policies concerning the organization, financing and the provision of diagnosis, care and cures to ill people developed along three fragmented tracks: (a) EU public health policies concerning the well-being of all people; (b) the application of the free movement principle to national healthcare systems in particular by the EU’s Court of Justice (CJEU); and (c) the austerity packages and the stricter EU surveillance of national budgets since the debt crises.

The key questions of this special issue are whether this fragmented EU involvement has now developed into a distinct European healthcare union, and if so what its driving forces have been. Thus, it explores how European integration in healthcare has moved forward despite widespread reluctance. It also examines the underexplored political dynamics and implementation of CJEU case law.

The conclusion is that a fragile European healthcare union is emerging. A distinct area of EU health law has come into existence, whereas an institutional structure has given a voice to health expertise. A certain commonality in patients’ rights has also emerged. The EU’s budgetary surveillance deeply intrudes into healthcare policies, but here the involvement of health actors has remained limited.

The European Commission and the CJEU have played an important role in the European integration of healthcare policies, but reluctance towards EU intrusion into national healthcare systems left an emphatic mark on CJEU case law, its codification in EU law and its implementation. Variants of the multiple streams approach appeared to be helpful to explain this evolution.